What’s the craziest thing you’ve ever seen?

Signed, your friendly neighborhood emergency doc.

Hey stranger,

I know you’ve just gotten word of what I do for work. There’s much more to me than this job, by the way, but I guess we are already going down this path.

I can assure you that 1) yes, I do have a cool (chaotic) job, and 2) you do not, in fact, actually want to know the craziest thing I’ve ever seen.

I don’t have a good answer for you. After all these years.

The craziest thing I have ever seen is someone die. Multiple people dying…

Unfortunately, the first thing that comes to my mind when I’m asked this question is death.

But that’s no fun, right? Morbid. Wouldn’t fare well in a social gathering.

What about me, a few years ago; a resident physician on hour-20 of a weekend call shift. I am terrified and forced awake by the unnatural sounds and complexities of the surgical-ICU, willing myself to make it through the next 4-8 hours so I can leave the hospital without harming anyone.

Seems unstable. And sad.

How about my strained out of town relationships, wondering why I haven’t been present or checking in as often as before…

Doesn’t seem fitting for the question. And a bit whiny even, no?

Honestly, there are not as many things stuck in as many places as you would think. Is a foreign body still exciting to folks?

I’d honestly rather not think too hard about these.

Hmm… “end-stage” addiction?

The kind that’s so difficult to treat that all the medications in the hospital pharmacy cannot stop the withdrawal symptoms.

The kind so debilitating that someone’s necrotic flesh is consumed by maggots in front of you.

The kind that forces people to leave the hospital with these open wounds and active infections.

The kind that kills you… (Ah, here we are again)

What about a gift gone awry? A nice holiday candle that turned out to be dynamite.

A stick of dynamite.

A stick of dynamite that blows extremities to el infierno.

How can I talk about that though, without remembering who was left. And all the other trauma that comes with entering a trauma or resuscitation bay.

How about what happens before patients come into the hospital? Law enforcement officers literally scooping patients in their car, sans seat-belt, to quickly get them to a hospital after a gunshot wound. Such a strange, and in all honesty, crazy phenomenon. Like law enforcement in protected treatment spaces to begin with.

What about the patients with housing insecurity coming to the emergency department with a suitcase full of everything they own, and a smaller bag with nothing but a room temperature salmon fillet. Bizarre.

We have our few regulars that we see in the emergency department, quite literally every day, more than some of our relatives.

Every day we offer socks and a turkey sandwich, a temporary surrogate for food and shelter.

How can I possibly answer your question without noting the real impact of food and housing insecurity on the health of so many of my patients? Or that my emergency medical intervention for chronic food and housing insecurity is solely dependent on the availability of this turkey sandwich?

Maybe I can talk to you about the miracles?

Electricity quickly helping a heart beat normally, or start beating at all.

Medications and technology helping people breathe, urinate, defecate, and nourish their body early and often.

The fact that there are options for treatment after I tell someone they likely have cancer, or a major organ is failing.

Science!

The patients who have been conditioned by years of hurt to trust google, AI, and social media more than their care team.

The patients who say thank you.

The patients.

My beautiful colleagues.

I can continue, but none of these thoughts can fully capture everything that comes to mind when I hear your question without much more context.

It’s a crazy thing to see people dying. And it’s even crazier when they are surviving.

We–patients and clinicians alike–are somehow surviving, despite so many unmet basic needs.

That is absolutely crazy. 

Does that answer your question?

Brenda Arthur (she/her) is an emergency medicine physician and an assistant professor of emergency medicine in Philadelphia. She is currently pursuing her master’s in health justice and bioethics as an urban health fellow with the Pincus Family Foundation.